Healthcare Provider Details

I. General information

NPI: 1033114194
Provider Name (Legal Business Name): MICHAEL IRWIN UNTERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL IRWIN UNTERMAN MD

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W RENAISSANCE BLVD
FARMINGDALE NJ
07727-4335
US

IV. Provider business mailing address

121 W RENAISSANCE BLVD
FARMINGDALE NJ
07727-4335
US

V. Phone/Fax

Practice location:
  • Phone: 732-757-2385
  • Fax: 732-280-5479
Mailing address:
  • Phone: 732-757-2385
  • Fax: 732-280-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA04215400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: